Firm but fair Cand with lots of warmth by yurtgc548


									                                                                                                                                                      NEWSLETTER FOR THE FRIENDS
                                                                                                                                                      AND STAFF OF YOUTH HORIZONS
                                                                                                                                                      MAY 2008 | ISSUE TWO

  ‘Firm but fair –and with                                                                                                   P1+2    Treatment Foster Care (TFC) ‘Firm but fair –
                                                                                                                                     and with lots of warmth’

       lots of warmth.'   TREATMENT FOSTER CARE (TFC)
                                                                          TREATMENT FOSTER CARE (TFC)
                                                                                                                              P2     Messages from Cath Handley and Ngarau

                                                                                                                                     Youth Horizons’ clinical team

                                                                                                                              P3     Board member profile – Dr Ian Lambie

                                                                                                                              P4     Hamilton’s Special Family Home

                                                                                                                                     LNSCD Programme (Lower North Island
                                                                                                                              P4     Severe Conduct Disorder)
                                                                                                                                     ‘Targeting very challenging boys’

                                                                                                                              P5     Auckland Bridging Programme (ABP)

                                                                                                                                     Multi-systemic therapy (MST) ‘Empowering
                                                                                                                              P6     families’

                                                                                                                                     High and Complex Needs (HCN)
                                                                                                                              P7     Treatment for young people with severe
                                                                                                                                     anti-social behaviour

                                                                                                                                     Staff Profile - Dave Robertson, Youth
                                                                                                                               P8    Horizon's Clinical Director

                                                                                                                                     The 100km charity walk

                     Left to right; foster parents Lorraine and Frank Darcy with Nicholas McCarriston.
                                                                                                                                   STOP PRESS
                                                                of them, the work is a labour of love. We’re in awe
  ‘We ensure that the placements are safe and
                                                                of what they do in their homes. They’re a fantastic
                                                                group of people and are the most important part
                                                                                                                              AGGRESSION REPLACEMENT
  that what’s supposed to happen is happening.                  of our treatment programme. They have to be able                   TRAINING (ART)
  We look for a warm family environment                         to remain calm in the face of sometimes extreme
  where the lines of communication are open                     provocation. These kids can try to get their needs             Professor Gundersen NZ workshops
  to everybody. A good therapeutic environment                  met in coercive ways.’
                                                                                                                            Limited to 20 places per one-day seminar
  needs to be caring, firm, but fair, and with lots                                                                       Venues: Auckland, Hamilton & Wellington (tbc)
                                                                The young person is placed within the caregiver
  of encouragement,’ says Treatment Foster Care                 couple’s family home. After a year the young person
  Co-ordinator Nicholas McCarrison.                             is returned to his or her home and followed up by
                                                                CY&F.                                                               Dates: 28th July – 01 August
Nicholas has been with Youth Horizons for four                  ‘The majority of our kids return home. The average                     Venue: Youth Horizons
years. He oversees the foster care placements, recruits         age of the child under our care is 13 or 14. Although      Cost: $500.00 per person (one-day workshop)
the caregivers and is responsible for their intensive           we’ll take a child as young as ten or up to 16. If so,    Info: Philippa Wilson, 09 573 0954 extn 272
programme of training and for their support. His                they’ll be discharged at 17.
role requires him to be patient and diplomatic, as
well as a multi-tasker and very organised.                      ‘They are referred by CY&F, are predominantly boys
                                                                and are from diverse backgrounds. Some have Severe                                    Knut Gundersen
‘We have a higher than usual retention rate of                  Conduct Disorder, others may have been in trouble                                     Associate Professor and Head
caregivers at Youth Horizons. The average life of               with police or have Attachment Disorder (difficulty                                    of Department for Rogaland
a caregiver is two to three years because it’s such a           creating and maintaining strong relationships) or
                                                                mental health issues. Children may present with two                                   University College, Norway,
hard job. Our caregivers are provided with a lot of                                                                                                   and Advisory Board Member of
support, not only from me but also from the social              or three of these problems. Some of these conditions
                                                                manifest in children as young as seven, but there                                     the International Centre for
worker and psychologist.
                                                                aren’t many programmes for very young children.                                       Aggression Replacement
‘We have 23 caregivers, mostly couples. For most                                                  (continued on page 2)                               Training (ICART). Knut
                                                                                                                                                      is a much published author in
                                                                                                                                                      the area of social competence,
            This newsletter is printed on recycled paper called Harvest Silk and is included in the FSC                                               environmental therapy and
   (Forest Stewardship Council) programme. FSC is a programme designed to recognise paper derived                                                     networking. He is involved in
                                           from sustainable forests and processed through certified mills.                                             the implementation of ART in
                                                                                                                                                      Norway, Iceland and Russia.
By the time they reach 12 or 13, their problems can already be entrenched.’                                                   Youth Horizons Behavioural Psychologist Charles Heywood is involved in
                                                                                                                              assessment of the programme’s efficacy. He creates behaviour assessments and
The caregivers have an on-call 24/7 team that includes Nicholas, a social worker                                              treatment plans for the children. He also trains staff in the points system, the
and psychologist Charles Heywood. They provide rostered support.                                                              standard behaviour management system used by YH.

‘Multi-dimensional Treatment Foster Care is one of three evidence-based models                                                ‘The efficacy of Youth Horizons’ treatment foster care looks promising, but it’s
that consistently show efficacy across cultures in the treatment of Severe Conduct                                             an open question at present, because this is relatively young programme so we’ve
Disorder, alongside Functional Family Therapy and Multi-Systemic Therapy,’ says                                               been monitoring a number of different outcomes over the past two years,’ says
Youth Horizons Clinical Director Dave Robertson. ‘Our programme has been                                                      Charles. ‘Long-term results are only just beginning to trickle in.’
strongly influenced by the Multi-Dimensional Treatment Foster Care (MTFC)
model developed by the Oregon Social Learning Centre, as it stands head and                                                   TFC Auckland-based foster parents Lorraine and Frank Darcy have been with
shoulders above other treatment foster care models. We have a long-standing and                                               Youth Horizons since 2002. ‘We only ever have one child at a time and they stay for
positive relationship with the Oregon team.’                                                                                  12 to 18 months,’ says Lorraine. ‘The biggest challenge is that my own weaknesses
                                                                                                                              are shown up. I’ve had to learn to manage my reactions and to manage the young
Dave has been working in the area of Severe Conduct Disorder at Youth Horizons                                                person’s. They can test you and it’s easy to feel like you could lose your cool. One of
for four years. ‘I’m very interested in MTFC and in bolstering that sector in our                                             the girls we had was very “mouthy”. She could be very annoying, with nasty, malicious
organisation. MTFC is presently underdeveloped in this country. Functional                                                    behaviour at times, but then could be charming at others. Non-compliance was the
Family Therapy is not applied here. Even MST (multi-systemic therapy) has only                                                only way she had learned to gain attention. Some of the boys get a bit boisterous
been in New Zealand for about six years.’                                                                                     and occasionally trash their rooms. We’ve only had two do that.

MTFC involves delivering treatment to the child and their family through a                                                    ‘The training and support we’ve received from YH is excellent. There’s always a
managed therapeutic care relationship. ‘The caregiver parents are used as a key                                               support person available who can call us back within five minutes if we need help
element of delivering treatment. They form part of a wider treatment team and                                                 or advice. If someone is having a tantrum, you can’t just walk away.
apply treatment principles alongside appropriate care. MTFC is intensively
supported, goal-oriented and time-limited, with a number of evidence-based                                                    ‘The most rewarding thing is learning from other caregivers during the times we
outcomes.                                                                                                                     meet twice a month. It’s very satisfying to observe even small improvements in a
                                                                                                                              child’s behaviour.’
‘MTFC achieves far fewer failed placements,’ says Dave. ‘In regular foster care,
kids frequently move from one care situation to another, leaving burnt-out                                                    The average age of the children who stay with Lorraine and Frank is 14. They are
parents in their wake. With MTFC , the experience is that there is a third the                                                parents of sons themselves, and most of their foster children have been boys.
rate of foster parent attrition and significantly fewer behaviour problems. In
addition, the kids are usually better at managing their stress levels, and have a far                                         ‘Our current foster boy is very motivated, fitting in well and attending Felix Donnelly
better reunification with their original family. We know through evidence that                                                 College,’ says Lorraine. ‘He’s into rugby league and goes to practice a couple of
MTFC leads to fewer young people in police custody, prison, secure custody                                                    nights and to the gym a few times a week.’
and they run away less often.’

Evidence-based Programmes                                                                                                              Windows of Opportunity
  Kia ora tatou katoa                                                                                                            Kia ora tatou katoa

  In March I attended the Blueprints Conference in Denver, a conference dedicated to                                             Support is always available to those who choose to enter the realm of opportunity.
  showcasing evidence-based programmes* for youth offenders.                                                                     Youth Horizons is dedicated to providing support for those in need. These are
                                                                                                                                 challenging times for our young people, but our clinical staff, social workers and care
  The programmes are rigorously assessed by the University of Colorado and must meet                                             workers thrive on challenges.
  a number of criteria to be Blueprints-endorsed. In particular, they must show sufficient
  quantitative evidence of being effective over time and be able to be replicated in other sites.                                This world was not meant to be an easy place. Regardless, we do have choices
                                                                                                                                 and the choices we make today determine our tomorrow. Once whanau have
  The western world is focussed on addressing the problem of youth offending.                                                    chosen us then they should not expect us to provide anything that is less than ideal.
  Increasingly, evidence-based programmes are required to meet funders’ expectations.                                            Youth Horizons is committed to developing a bi-cultural approach to treatment. To
  New Zealand is similarly focussed.                                                                                             provide a sound bi-cultural service, we need to have our values and kaupapa solidly
                                                                                                                                 integrated throughout all of our clinical, social and therapeutic services. We are
  Youth Horizons was set up eleven years ago as an evidence-based organisation
                                                                                                                                 working towards achieving this and we have a strategy and business plan to support that
  specifically to provide programmes for young people with severe conduct disorder.
  We now have a range of programmes which are evidence-based, including MST, one
  of the most highly regarded Blueprint programmes. We are analysing other Blueprints                                            Na
  models that may be adapted to become culturally appropriate so Youth Horizons will
  be relevant for more New Zealand young people at extreme risk.                                                                 Ngarau Tupaea

  Naku noa na                                                                                                                    Youth Horizons Kaumaatua
  Cath Handley
                                                             *Evidence-based programmes are based on the best
  Youth Horizons CEO                                         available, current, valid and relevant scientific evidence.

                                    Our Clinical Team
Maria Ludbrook, Clinical Psychologist, M.Soc.Sci(Hons),
    PGDipPsych(Clin), Clinical Leader, Te Hurihanga
                                                                  Michael Williams, Clinical Psychologist,
                                                                   MScHons, PGDipClinPsych, MNZCCP
                                                                 Clinical Director, Auckland/Wellington Region
                                                                                                                                              Eric Messick, Board Certified
                                                                                                                                                 Behaviour Analyst, PhD,
                                                                                                                                             Clinical Advisor, Waikato Region

                                                                                                                                   Shayola Koperu, Registered Comprehensive Nurse,
                                                                                                                                        Clinical Advisor, LNSCD Programme
                                                                    Charles Heywood, Psychologist, PhD,
                                                                        Auckland Bridging Programme
        Dave Robertson, Clinical Psychologist,
        MA(Hons), PGDipClinPsych, MNZCCP
         Clinical Director, Waikato/BOP Region

                                                                                             experience to the board to assist in clinical      further develop its evidence-based clinical

                                          Safe Ian Lambie
                                                                                             Ian is also involved in Youth Horizons’
                                                                                             clinical appointments, reviewing CVs and
                                                                                                                                                services, such as Treatment Foster Care
                                                                                                                                                and consider developing Functional Family
                                                PhD, P.G.DipClinPsych, DipBus                with the interviewing process.                     Ian was a consultant to the Ministry of
                                                                                                                                                Youth Affairs from 1994-2001 for their
                                                                                             Jill Worrall, co-chair of Youth Horizons’
                                                                                                                                                youth at risk programmes. He is currently
                                        A Youth Horizons Trust Board member                  board, says that the Trust is most fortunate
                                                                                                                                                a consultant to the Government on youth
                                        since 2001, Ian Lambie is currently a Senior         to have Ian on the board. ‘He is held in high
                                                                                                                                                offending and a member of the Ministry
                                        Lecturer in Clinical Psychology at the               esteem in his field and brings a professional
                                        University of Auckland, where he teaches             and clinical perspective to issues the board       of Justice Independent Advisory Group on
                                        clinical, forensic and child psychology.             has to manage. In particular, he is currently      Youth Offending, chaired by Judge Becroft
                                                                                             overseeing the setting up of a professional        and the Ministry of Social Development
                                        For over 18 years he has been providing                                                                 Expert Group, on the treatment of Conduct
                                        treatment for adolescent offenders, first at          advisory committee of experts who will
                                                                                             bring to the Trust, advice on models of            Disorder.
                                        the Leslie Centre and then by establishing
                                        the adolescent programme at SAFE. His                practice and other clinical issues.’               He is a member of the New Zealand
                                        specialist clinical and research interests are       ‘I’m looking at the role the organisation          Psychologists Board Disciplinary Tribunal,
                                        youth forensic psychology and in particular          is playing and how it can be linked with           as well as the consultant psychologist for
                                        Severe Conduct Disorder, adolescent sexual           key people in the community from Maori,            the New Zealand Fire Service National
                                        offending and arson.                                 CY&F, psychology and education who                 Fire Awareness and Youth Intervention
                                        ‘Professor John Werry, the godfather of              could pick up various roles on the advisory        Programme. In 2001 he was the youngest
                                        child psychology in New Zealand and one              committee,’ says Ian. ‘This committee would        recipient to receive the New Zealand
                                        of the former YH trustees, asked me to be a          operate separately from the Board, but             Psychological Society Public Interest Award
                                        member of Youth Horizons’ Board,’ says Ian.          report to it and to the social agencies which      for his longstanding community work with
                                        ‘I bring an understanding of the difficulties         feed information into it. We would provide         adolescent sexual offenders in New Zealand.
                                        and rewards of working with youth with               guidance about service delivery and look at        In 2006, he was awarded a University of
                       Dr. Ian Lambie   severe behaviour problems, as well as the            issues of risk and clinical development – for      Auckland Science Faculty Teaching Award
                                        benefits of my ongoing clinical and research          example, whether Youth Horizons should             for excellence in Teaching.

                                  A special family home
Left to right; Anaru Nathan, (specialist youth worker), Richard Parangi (house parent),
       Teire Parangi (house parent), Derek Rautahi (senior specialist youth worker),
                     Don Derecourt (care coordinator/social worker).

                                                 Providing placements for up to five boys, Hamilton’s Specialist Family Home
A typical youth will have one or more          is located in the Hamilton suburb of Te Rapa. It is a modified five-bedroom                                    complex undertaking to convince a
behavioural issues, but the primary            family-style home with an attached flat to accommodate the houseparents.                                      youth who believes otherwise that
diagnosis must be Conduct Disorder.                                                                                                                         he possesses an inherent value in
The youths range from 12 to a                                                                                                                               simply being.’
maximum age of 16. The average age is 13            Boys earn their individual points and reap      permanent staff of two houseparents and a
or 14. Their time in residence ranges from          privileges for good behaviour or executing      specialist youth worker, as well as a half-time
                                                    set chores. ‘It normally only takes a boy a few specialist youth worker. Psychology input is       ‘It’s never a smooth road,’ says Richard. ‘It
six to 12 months.                                                                                                                                      takes a while for a boy to adjust to a different
                                                    days to work out the points system, to settle   also available for the boys.
                                                    down and try to conform to the household                                                           way of doing things. I think the points and
‘Places here are highly sought after,’ says Don                                                                                                        rewards system is the best thing since sliced
Derecourt, coordinator/social worker at the         norms. The points system also dictates the      Richard and Teire Parangi have been house-
                                                    amount of pocket money each boy receives.       parents at Hamilton House since 2002.              bread. It helps the boys to comply and to
facility. ‘All of the boys have been referred
by CY&F with a background report of their                                                           Their own children are now adults and living       practise what we’re trying to teach them.
issues and relevant clinical assessments.           ‘Rules they see as fair, a behavioural system   elsewhere. The couple are currently caring         Television or radio time slots are potential
When a child enters our house we have them          they understand and staff they can respect,     for up to five teenage youths in the house.         daily rewards depending on their behaviour.
checked by our local GP, a dentist and a            produces a calming effect on the boys, and                                                         The boys take their performance sheets
physiotherapist, to ensure that routine issues      provides a routine to which they respond        ‘The intricacies of this type of residence         to school and we get daily reports from
have not been overlooked. From the point            well. Lack of routine seems to confuse and      often require balancing competing interests in     teachers. The data is fed into the computer
of entry the boy commences a behavioural            upset them.’                                    order to provide the best environment              along with other information like house
programme which was designed specifically                                                            in which a youth’s best interests can be           behaviour and hygiene standards to tally the
for Hamilton House.’                                In addition to Don, the house supports a        realised,’ says Teire. ‘It’s a difficult and        rewards points.’

                                                                                                                                                       An important aspect of Leti’s role is to create

                                                    ‘Everybody is against us.'                                                                         and support the boys’ career pathways, which
                                                                                                                                                       can include arranging work experience and
                                                                                                                                                       after school programmes. He also liaises
                                                                                                                                                       with education providers and gives feedback
                                                              TARGETING VERY CHALLENGING BOYS                                                          to the young person and to his family.

                                                                                                                                                       ‘I liaise with community providers, drug
                                                    LNSCD (Lower North Island Severe Conduct Disorder) is a three-stage programme                      and alcohol counselling services and walk
                                                    aimed at boys who have committed offences, are anti-authority, violent, break rules,               alongside the young people as they deal
                                                    are deceitful, run away and who may be disconnected from the education system.                     with the Youth Justice system,’ says Leti.
                                                    Capital & Coast DHB is contracted by CY&F           Stage One. He earns the privilege to spend     ‘Another aspect of my role is to report back
                                                    to run the first two stages of the programme.        weekends at home with his family.              to the clinical advisor and treatment team
                                                    Youth Horizons provides stage three and is                                                         regarding any risk indicators.
                                                    involved in discussions about each boy from         At Stage Three the boy is back either living
                                                    the beginning.                                      at home or with approved caregivers in         ‘We create a support team that works
                                                                                                        his community. The boy and his carers are      alongside the boy and his family. You need
                                                    Stage One takes place in a secure facility in                                                      a positive attitude to work with these boys.
                                                                                                        provided with intense levels of support by
                                                    Lower Hutt with three sets of staff rostered                                                       The kaupapa and culture of our Youth
                                                                                                        the Youth Horizons team including an MST
                                                    24/7. Ten beds are available for boys aged                                                         Horizons’ Wellington office is a key element
                                                    from 13 to 16. The boy remains in this first         therapist for 18 months.
                                                                                                                                                       in achieving results.’
                                                    stage a minimum of three to four months
                                                    until his behaviour has been modified                Twenty-three-year-old Samoan specialist
                                                    sufficiently for him to be moved on to the           youth worker Leti Avei is a member of the      ‘Leti plays a very significant role on
                                                    next stage. Five teachers are employed to           four-person Wellington Youth Horizons          this programme. He co-ordinates
                                                    educate the Stage One & Two boys within             team providing stage three of the LNSCD        services, provides damage control, and
                                                    an on-site school.                                  programme. He has recently gained a            is a mentor to these boys,’ says Clinical
                                                                                                        National Mental Health Support Workers         Advisor Shayola Koperu. ‘Leti helps to
                                                    Stage Two is a transition phase where the           Certificate, which has given him a greater      create opportunities for them to explore
                                                    boy is moved to a non-secure house located          understanding of Severe Conduct Disorder.      alternative directions. He works with
                                                    in the community for two to three months            He is about to commence study towards a        our team to develop hope in these boys,
                                     Leti Avei      and builds on the skills he has learned in          Bachelor of Social Work this year.             where none existed before.’

Auckland Bridging Programme (ABP)
    Established in 1997, the Auckland Bridging Programme (ABP) was originally
    a residential-only service for young people diagnosed with Severe Conduct
    Disorder. In 2004 therapeutic foster care was introduced into the programme
    followed in 2005 by MST (multi-systemic therapy, a home-based intervention)
    to promote successful family reintegration and family preservation.

All referrals come from CY&F’s Auckland           foster care placements or the residential
regional sites, accompanied by a diagnosis        houses in Grey Lynn or Onehunga. These
of moderate to Severe Conduct Disorder.           two houses are run by couples who live
The ABP offers three care modules: MST,           and work in the house with support staff
foster care and residential care. There are 13    who work together to create a family-type
residential beds (in Manurewa, Grey Lynn          environment.
and Onehunga), 10 contracted foster care
placements and a four-person MST team.            The ABP Residential Programme is a form
                                                  of group home residential treatment similar
Out-of-home placements are used to
                                                  to the Teaching Family Home (TFH)
stabilise extreme behaviours in situations
                                                  model which originated in the USA.
where it’s not feasible for the young person
to remain with the family. The aim is to
reduce the frequency, severity and intensity      ‘Residential treatment has been over-
of problematic behaviours. Once behaviours        shadowed by newer programmes such as
have been stabilised, family re-integration       MST and Treatment Foster Care (especially
is the preferred option, often using MST.         Multi-Dimensional Treatment Foster Care)
                                                  and the excellent research outcomes the
The diagnosis of Conduct Disorder is              latter has obtained,’ says Youth Horizons
determined by the number and severity of          Psychologist Charles Heywood. ‘One of
behavioural symptoms exhibited by the             the great advantages cited for MST and
                                                                                                                                                      Clare Babbage
individual: at least three of 15 behaviours in    Treatment Foster Care is that delinquent
the areas of aggression to people and animals,    youth aren’t grouped together in one setting,
destruction of property, deceitfulness, theft     as they are with Residential Treatment.                behaviour and their families. It focuses           ‘At ABP we plan the young person’s entire
and serious violations of rules are required.                                                            on working with the family to manage               programme to ensure that the treatment
                                                  Clustering high risk youth is problematic
In order to receive a diagnosis of Severe                                                                the young person’s difficult behaviour,             will be comprehensive and effective. The
                                                  because they will often model and encourage
Conduct Disorder, the individual must                                                                    following priorities set by the family and         plan is completed before the placement
                                                  each others’ anti-social behaviour. On the
exhibit many behaviours in excess of the                                                                 other stakeholders.                                starts. We also have a regular review
                                                  other hand, Teaching Family Homes has
minimum of three, or behaviours which                                                                                                                       process which allows the young person
                                                  obtained some good results in the literature                                                              and those involved with them to review
cause considerable harm to others.                                                                       ‘Our aim with MST is to work with the
                                                  and this is in line with our experience. For                                                              their progress,’ says Clare.
                                                  instance, in a recent analysis of behavioural          parents so they can manage the behaviour
Young people displaying the most severe                                                                  of their child with interventions such
problems are placed in residential care in        incidents for 50 ABP residential young                                                                    ‘We’re currently involved in a lot of family
                                                  persons from 1999 to 2006, the number of               as rules and boundaries and increased
Manurewa, where there are rostered staff                                                                                                                    group conferences with young people
                                                  incidents for the last three months of their           monitoring,’ says Programme Manager                through the Youth Justice system and a
and high levels of monitoring. An activity
plan is put in place, as well as a points         stay was just under half the number for the            Clare Babbage. ‘The therapist identifies            pilot scheme at the Auckland District
system of rewards and consequences.               first three months.’                                    which behaviours are problematic, looks            Court – the Intensive Monitoring Group
Young people whose behaviour is less                                                                     at what is causing the young person’s              set up by His Honour Judge A J Fitzgerald.
extreme and who do not require the same           MST is an effective approach to working                behaviour, and with the family works out           We will soon conclude our work with the
high level of monitoring are placed in            with young people with anti-social                     strategies to manage them.                         first case in our care from this scheme.’

                                Case Study
                                A 13-year-old boy entered the Youth Horizons’ ABP programme in 2006 and left in 2007. Diagnosed with Severe
                                Conduct Disorder, he had already been in several placements and responded reasonably well. However, he always
                                experienced difficulties on returning home and exhibited very disruptive behaviour in his school environment.

                                Two goals were established: to return him to his family and to re-engage him with education. This would require
                                reducing his problematic behaviour – yelling, abusive language and intimidation of other school children.

                                He was placed by the ABP at Felix Donnelly College, where he progressed well. In less than two terms he was
                                transitioned into a mainstream school. He had student aid support through Group Special Education (GSE).
                                He built some good relationships in the mainstream school and made it through to the end of the year.

                                Getting him into a mainstream school was a major achievement. It involved the boy facing his fears and coping
                                with the potential stigma of having student aid support both in and out of the classroom. He was discharged
                                from residential care after his extreme verbal behaviours had been reduced. With the support of MST he
                                returned to live with his mother. He can now maintain his schooling to take him to the next step of achieving
                                his work goals, via skills-oriented training.

                                  For further information please contact Clare Babbage, Programme Manager Tel: 09 573 0954, ext 207 or cell: 021 673 872

                        Empowering families
                  of very challenging young people
                                                                                          Multi-systemic therapy (MST) is an intensive family
                                                                                          and community-based treatment that addresses the
                                                                                          multiple causes of anti-social behaviour in children
                                                                                          and young people. It targets young people who have
                                                                                          serious problems, such as violence, alcohol and drug
                                                                                          abuse, and offending.

                                                                                                                     in pro-social activities. It might be that the parents
                                                                                                                     can’t pay fees, or they don’t show encouragement.

                                                                                                                     It might be due to location factors or simply because
                                                                                                                     no one has taken the child to an activity.’

                                                                                                                     MST is provided using a home-based model of
                                                                                                                     service delivery and is available on a 24/7 basis. This
                                                                                                                     model helps to overcome barriers to service access,
                                                                                                                     increases family retention in treatment, allows for
                                                                                                                     the provision of intensive services (therapists have
                                                                                                                     low caseloads), and enhances the maintenance of
                                                                                                                     treatment gains. The usual duration of intensive
                                                                                                                     MST treatment is around five months.

                                                                                                                     ‘The MST approach works for both boys and girls,
                                                                                                                     although boys make up around 65 per cent of our
                                                                                                                     MST cases in New Zealand. The programme is
                                                                                                                     adapted to suit the requirements of each young
                                                                                                                     person. It’s one of the few approaches known to
                                                                                                                     address young people’s behaviour in the short-term
                                                                                                                     and have long-term sustainable outcomes.’
                                                 Justine Harris                                                      The first controlled study of MST with juvenile
                                                                                                                     offenders in the US was published in 1986, and since
                                                                                                                     then seven randomised clinical trials with violent and
MST clinicians are trained and supported by MST            workers and community workers. The ideal person
                                                                                                                     chronic juvenile offenders have been conducted in
New Zealand (MST NZ), a company formed in                  has psychological knowledge and the practical skills
2001 and set up as a charitable trust. It was created      of a social worker. Therapists need to have the ability   the US. In these trials, MST has demonstrated long-
to disseminate MST within New Zealand, on behalf           to get out there and engage with a variety of people,     term reductions in criminal activity, drug-related
of agencies wanting to deliver MST to families of          and be prepared to be creative, flexible and adaptable     arrests, violent offences, and inprisonment.
young people with anti-social behaviour. MST NZ            – it’s not for people who would prefer an office-based     ‘The success of MST can be measured in a range of
provides leadership and assistance with all aspects        position. What’s required is the “whatever it takes”      ways,’ says Justine. ‘Instrumental outcomes such as
of programme development, clinical consultation,           mentality.’                                               – Is the family better at parenting? Do they have
staff training and implementation. There are now 10                                                                  better skills? Is the child associating with pro-social
teams delivering MST across New Zealand. Youth             The main aim of MST is to empower parents with the
                                                           skills and resources needed to independently address      peers? How is the child progressing? And ultimate
Horizons is one of five agencies delivering MST.                                                                      outcomes – Have the young people reduced their
                                                           the difficulties that occur when raising teenagers.
After start-up, training continues through weekly          The objective is to empower youth to cope with            offending? Are they attending school and living in
telephone MST consultation for each team of                family, peer, school, and neighbourhood problems          the community?
MST clinicians. The weekly consultation is aimed           now and in the future.
                                                                                                                     ‘Through faithfully applying the MST model with
at monitoring treatment fidelity and adherence to
                                                           Within a context of support and skills-building,          families, we are definitely reducing offending and
the MST treatment model. Further training and
                                                           the therapist places developmentally appropriate          increasing the days that a young person spends at
monitoring also takes place at face-to-face quarterly
                                                           demands on the adolescent and family. Intervention        home, rather than in care. Our organisation follows
on-site booster training sessions (one and a half days
                                                           strategies include strategic family therapy, structural   up with the family and the young person at six-
for each team).
                                                           family therapy, behavioural parent training and           monthly, 12-monthly and two-yearly intervals post-
‘We’re the MST regulators,’ says MST NZ CEO                cognitive behaviour therapies. The MST therapist          treatment to check if these outcomes are ongoing.’
Justine Harris. ‘If MST is delivered with fidelity it       works as part of a team in the family environment,
                                                                                                                     An external evaluator is used for the follow-up
works. We evaluate each clinician’s work from an MST       addressing whatever issues may be causing the young
                                                                                                                     procedures. ‘We obtain data from the police, family,
expert’s perspective and provide weekly guidance and       person to misbehave. These may include associating
booster training in any areas in which they may be         with the wrong crowd or parents not knowing how           school and social services to measure the child’s
struggling. Each year we provide refresher training        to enforce consequences.                                  progress, so it’s very practical. There appears to be
for the 30 or so currently practising MST therapists,                                                                no difference in outcomes for families of different
as well as providing introductory training for 10 to       ‘The team ensures that the child gets to school,          cultures, no difference in outcomes between Maori,
15 new MST therapists.                                     encourages them into pro-social activities and teaches    Pacific Island or Pakeha young people. The majority
                                                           the parents to set rules and enforce consequences. We     of families benefit from the approach and can see
‘Our MST therapists include psychologists, social          look at the reasons why a child might not be involved     their young person succeed,’ says Justine.

   H C N – Treatment for young people with
           High and Complex Needs
                                                         services in two or more sectors – education, health and      unrecognised psychiatric illness, which has
  Severe anti-social behaviour in                        disability, and CY&F.                                        restricted a child’s ability to focus or to function
  children and young people requires                                                                                  effectively. Ongoing psychiatric case management
  an integrated response.                                ‘The HCN programme is designed to create services            includes reviewing the child’s mental state and their
                                                         for young people who would otherwise fall through the        responses to medication.
                                                         cracks,’ says Youth Horizon’s Behavioural Psychologist
The High and Complex Needs Interagency                   Charles Heywood. ‘We have a trickle of these kids            ‘The programme is being continually tailored to the
Strategy was developed in 2001 as a joint initiative     coming through. They tend to have a high level of            needs of each child,’ says Andy. ‘The local HCN
of the Ministries of Health, Education and Social        needs and complex psychiatric and behavioural issues         team meets at least monthly and will usually include
Development and the former Department of Child,          and require funding to a very high level to manage           an educational or behavioural psychologist, a social
Youth and Family Services. The aim of the strategy is    them effectively. Very clear goals are set for each child    worker, representatives from CAMHS (Child and
to improve the success rates in changing the behaviour   from the outset. There is an equal mix of girls and boys     Adolescent Mental Health Service), HCN Advisors
of a small number of extremely challenging children      and they are generally aged between 12 and 15.               and Youth Horizons staff.
and young people, whose needs are not being met by
other services.                                          ‘These children occupy a great deal of my time. My           ‘The team will recommend a particular approach for
                                                         role is to conduct clinical assessments and to evaluate      the first six months, which may well be modified later.
A huge clinical input is required for each HCN           the effectiveness of treatment. I also create behaviour      This could relate to the therapeutic environment or
child – a dedicated team may include a psychologist,     plans and consult with staff and HCN co-ordinators.          to the type or levels of medication prescribed.’
social worker and psychiatrist, and may require the      There is no specific type of intervention for HCN,
provision of a house, a car and a dedicated specialist   the treatment and approach adopted will follow               The issues each child presents can vary considerably.
residential caregiver team.                              whatever is deemed appropriate for the individual            The most common issues relate to ADHD, combined
                                                         child’s situation by the interagency team.’                  with conduct disorder, or severe depressive and/
The HCN Unit supports the HCN Strategy by                                                                             or anxiety disorder such as obsessive compulsive
funding a short-term, intensive intervention aimed       Child psychiatrist Andy Parkin has worked with               disorder. Problematic personality features (such as
at producing significant changes in the behaviour of      Youth Horizons on a consultancy basis for the past           borderline traits) may also be factors in the mix. The
these young people, whose symptoms may place their       two years. Andy will become involved in instances            team has also treated less common presentations
caregivers under extreme stress, or may be causing a     where Youth Horizons is managing an HCN case for             such as conversion disorder (where an individual
risk to the child themselves or to others. A number      which funding has been provided for independent              has apparent physiological symptoms attributable to
of these HCN cases are referred to Youth Horizons        psychiatric assessment. He will assess the child at the
                                                                                                                      psychological sources).
by CY&F.                                                 time of entry to the programme and provide ongoing
                                                         medical management of the case, as required.
                                                                                                                      Each year about 100 children and young people will
To be eligible for HCN funding a young person must                                                                    receive support from HCN funding.
be under 21 and have needs that cannot be met by         ‘An initial assessment may uncover previously

        :: A CASE STUDY ::
       A 10-year-old boy had been in care for 18 months at the time CY&F                 a behaviour programme and a points system of clear consequences and
       referred him to Youth Horizons. He was described as extremely difficult to         rewards. The boy quickly settled in to the new regime. He was then moved
       manage and prone to violent outbursts and conversion symptoms when                into a supportive school that was aware of his background. Youth Horizons
       things didn’t go his way. He came from a family background of physical            developed an integration plan with the school and the local GSE (Group
       and suspected sexual abuse. He had been involved in an incident of                Special Education). The school was high decile and the principal was very
       severe cruelty towards animals, resulting in him being placed in a secure         supportive.
                                                                                         The caregivers identified the areas in which the boy excelled. He was a
       While he has maintained contact with his father, no family members                good athlete, so they got him involved in an athletic club. He was good
       were identified as suitable long-term caregivers, so Youth Horizons               at drama and they placed him in a theatre group. He was also enrolled
       selected a very experienced caregiver and her husband, who had                    in sea scouts. The boy also had regular contact with a YH social worker
       previously worked with children with severe conduct disorder. YH                  and psychologist, who tracked his incidents, pinpointing any behavioural
       established a relationship between the caregiver and the boy. They                triggers.
       exchanged letters and photos over a six-week period and then the
       caregiver and her husband met the boy and talked to staff. They got               The boy is now almost 12 and has been living with his caregivers for
       on well and the boy was happy to have them in his life.                           one and a half years. He walks to and from school and is fully integrated
                                                                                         into community activities. He has made outstanding progress. The next
       He moved into his new temporary home and his caregivers implemented               challenge is finding a long-term sustainable placement.

                   STAFF PR O FI LE - DAVE R O B E RTS O N, C LI N I CAL D I R ECTO R

                                                                          'It’s a fantastic job. Youth Horizons does
                                                                          great work with youth and whanau in
                                                                          very needy contexts.'
                                                                     he has worked in mental health and social service          over seven acres of native bush. ‘I like tramping and
                                                                     sectors ever since.                                        growing native trees. I’m cultivating a budding kauri
                                                                                                                                forest,’ he quips.
                                                                     His career has included working as clinical co-
                                                                     ordinator for a community-based adult mental health        Dave comes across as a gentle, thoughtful man and
                                                                     service, and inaugural clinical director of a national     it’s no surprise to discover that he is a published
                                                                     programme for high-risk adolescent sex offenders           poet. Time pressure dictates that his current mode
                                                                     under CYF custody, all of which were Christchurch-         of expression is haiku. This Japanese form of
                                                                     based roles. Following these he became national            poetry is characterized by one to four lines that
                                                                     clinical advisor for Barnadoes Specialist Services.        can be uttered in a single breath. ‘It’s easier in my
                                                                     He has been at Youth Horizons for four years as its        circumstances to come up with a snippet, a captured
                                                                     clinical director.                                         moment, a thin slice of life .’

                                                                     ‘I provide clinical direction for the Bay of Plenty,       He also cites the benefits of meditation for helping
‘Youth Horizons tends to attract people who are                      Waikato and Lakes area programmes, as well as              to maintain a work-life balance. ‘It helps me not
committed to changing the lives of adolescents and                   being a member of a national leadership team that          to take myself so seriously. I practise a form of
their families. It also attracts those interested in                 works to achieve the strategic direction of Youth          meditation based on the Vajrayana tradition within
delivering quality evidence-based interventions –                    Horizons and to develop clinical services across the       Tibetan Buddhism.’
I guess that would describe me. I also value being                   organisation.’
able to assist other like-minded agencies to build the                                                                          His work involves regular travel. He operates
capacity of the sector as a whole.’                                  As a very busy clinical director and also a father         f r o m o f f i c e s i n Ta u r a n g a , H a m i l t o n a n d
                                                                     of a five and a two year old and with a brand new           Auckland. ‘The travel gives me the opportunity
Dave graduated from Canterbury University in                         baby girl, Bella, Dave has his hands full. He lives        to clear my mind before and after work, so I’ve
1991, qualifying as a clinical psychologist, and                     in a tranquil spot outside Katikati, surrounded by         decided to view it as a bonus.’

                                           100km Charity Walk
   Left to right; Adele Saunders, Jennifer Garton, Kimberley Chalmers, Jaff Keeling.
                                                                                             Four Youth Horizons staff recently               Safety Coordinator Jaff Keeling. ‘They
                                                                                             participated on the 100km Oxfam                  stayed awake with us and provided food
                                                                                             Trailwalker in Taupo. Their efforts              and drink at the eight check points along
                                                                                             raised $2000 plus to support the                 the route. It was a tremendous team-
                                                                                             work of Oxfam New Zealand.                       building effort. We were excited and
                                                                                                                                              exhausted and I think we all wondered
                                                                                             A huge event, this year’s walk included          at times if we could actually walk such
                                                                                             250 teams each consisting of four                a distance. Participating in such an
                                                                                             people. They began the walk from the             event and the training that leads up to it
                                                                                             Taupo Events Centre at 6am on Saturday           enhanced our working relationships. We
                                                                                             5 April and walked through the day and           regularly trained together, walking up to
                                                                                             night to raise funds for Oxfam.                  70 kilometres at weekends.

                                                                                             Jaff Keeling, Adele Saunders, Jennifer           ‘At the finish we were elated that we had
                                                                                             Garton and Kimberly Chalmers took                achieved our goal. I’d be very keen to
                                                                                             just over 30 hours to complete the               take on the challenge again.’
                                                                                             walk, falling well within the official time
                                                                                             limit of 36 hours. Unfortunately, a calf         Oxfam NZ has developed an inter-
                                                                                             muscle injury preventing Jennifer from           national reputation for its development
                                                                                             completing the last 40 kilometres.               work in the Pacific and East Asia. It
                                                                                                                                              focuses on facilitating practical solutions
                                                                                             ‘We couldn’t have done the walk without          to the emerging crisis in water and
                                                                                             our amazing support crew of friends and          sanitation.
                                                                                             relatives,’ says Youth Horizons Health &

                                             BOP Respite Service                                Waitakere Youth Transition Services              YSS Specialist Caregivers Northern
                                             0800 737 748                                       0800 937 887                                     0800 375 210
                                             BOP Intensive Clinical Support                     Lower North Serious Conduct Disorder             Ka Awatea Auckland
                                             0800 356002                                        Stage 3                                          0800 375 210
                                             Waikato Intensive Clinical Support                 0800 942 368                                     Lighthouse (Boys Home) Auckland
                                             029 497 0335 or 07 838 3671                        Auckland Bridging Programme (Residential,        09 625 2164 or 021 673 155
                                             Te Hurihanga Waikato                               Fostercare & MST) Auckland Region                Lighthouse (Girls Home) Auckland
                                             07 856 9574                                        0800 375 210                                     09 576 8845 or 021 638 593
                                             Waikato Fostercare                                 High & Complex Needs North Island                YSS Hamilton House – Hamilton
                                             0800 026 878                                       0800 375 210                                     07 850 4575
                                             Lakes MST Rotorua
                                             0800 356 002 or 07 921 5120
                                                                                                     Youth Horizons, PO Box 22-365, Otahuhu, Auckland, New Zealand
                                                                                                       Phone 09 573 0954, Fax 09 573 0959,

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